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-Waste Tire S�. iey & Inspection Rep,---- p t SURVEY REQUIRED] <br /> ■ ,.:. <br /> �'�'_ State of California -- -- -- ----_--- �� <br /> CIWMB183 (New 04104) Comments Form <br /> California Integrated Waste Management Board BLUE OR BLACK INK PEN <br /> Business Profile Inspection Details <br /> TPID- Inspection t <br /> Site Suffix: b Report = 1 — 1 2 "1 2 3 S <br /> Number: <br /> Inspection Number on the associated Survey form(Page 1) <br /> Comments <br /> '\0C o.- -i cy\ <br /> 2- <br /> 42408 <br /> IF ,fir l A M P L E III <br /> White Copy:CIWMB Yellow Copy:Operator Pink Copy:LEA <br />